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Dr. Nirmal Raut

Colorectal cancer is the third most common cancer in the world, with 1.3 million new cases each year and a 5-year prevalence rate of 3.2 million. There were an estimated 6,93,333 deaths due to colorectal cancer (CRC) in 2012. When looking at India and the USA, the incidence, mortality, and prevalence rates are all consistently higher in the US. The incidence of the disease, however, is higher in males in both countries. In India, it is the fifth most common cancer after breast, cervix/uteri, lip/oral cavity, and lung cancer.

The westernized lifestyle of physical inactivity, poor diet, obesity, and increased alcohol consumption and long-term smoking attributes to this higher burden.

A review of the 12 population-based cancer registries in India (Benaguluru, Barshi, Bhopal, Chennai, Delhi, Mumbai, Ahmedabad, Karunagappally, Kolkata, Nagpur, Pune, and Thiruvananthapuram) demonstrated that the incidence of colon and rectal cancer is significantly lower in India for both genders when compared to that of the West. In these registries, colon and rectal cancer is ranked tenth among all cancers. The typical diet in India is lower in calories and consists of more fruits and vegetables. This, combined with a higher level of physical activity, translates into a lower obesity rate. Unfortunately, India’s low incidence rate is also associated with a low 5-year survival rate.

Patients with CRC usually present with rectal bleeding, pain, or a change in bowel habits. Occasionally, patients will present with a malignant large bowel obstruction. Once a diagnosis of CRC is made, the stage must be determined. This is achieved with the help of a CT of the chest, abdomen, and pelvis and an MRI of the pelvis or endoscopic ultrasound if staging rectal cancer. In addition, labs such as CEA and biomarkers of the tumor are obtained.

Chemotherapy has evolved in the past 20 years and now, there are multiple combination regimens available. Different combinations of chemotherapy and radiation are given to patients based on stage, tumor characteristics, and presence of biomarkers. Due to advances in the treatment of CRC and early detection, the survival rates have increased in the US, with a 5-year survival of 65% at all stages.

CRC detection and treatment has certainly made strides in the past few decades, especially in the USA and other economically developed countries. In other parts of the world such as India, the incidence still remains low and is less than half of that in the US. Nonetheless, the rate of CRC in India and other emerging economies such as Eastern Europe and South America is rising. In India, it is predicted to rise approximately by 80% in 2035, with an incidence of 114,986 new cases and a mortality of 87,502.

Efforts should be made for increasing formal screening programs in the age-appropriate population. Identifying people at a higher risk, such as those with a family history of colorectal cancer, a history of inflammatory bowel disease, or genetic conditions should be encouraged.

Finally, educating individuals about the risk factors and what should prompt them to seek care will help tackle this disease.

This article has been written by Dr.Nirmal Raut, Senior Consultant Medical Oncologist, Bhaktivedanta Hospital, Mumbai.